Motivators and Influencers of Adolescent Girls’ Decision Making Regarding Contraceptive Use in Four Districts of Zambia
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design
2.2. Study Setting
2.3. Selection of Study Sites
2.4. Study Participants and Recruitment
2.5. Data Collection
2.6. Data Analysis
3. Results
3.1. Motivators or Reasons for Contraceptive Use
3.1.1. Fear of Becoming Pregnant and Fear of Disturbing Their Education
“When you see your friend get pregnant or get sick at a young [age], you are motivated to use contraceptives so that you do not get pregnant.”[FGD 2, participant 5, Chikoyi Clinic, Luwingu]
“To protect myself from getting pregnant, because if I do not get that injection, I can get pregnant quickly.”[FGD 2, participant 1, Chongwe Clinic, Chongwe]
“You just make a decision on what you want in life such that you decide whether you want to get pregnant there and then or first go to school and live better. So, I have decided to use contraceptives.”[FGD participant 3, Chongwe Clinic, Chongwe]
“Some of us use contraceptives because say you are at school, I do not want to stop school because of pregnancy. I tend to use contraceptives while enjoying the sex till I finish school.”[FGD 1, participant 2, Location Urban Clinic, Kasama]
3.1.2. Fear of Sexually Transmitted Diseases
“We feel they [condoms] are safe to prevent us from getting diseases such as STIs.”[FGD 1, participant 9, Location Urban Clinic, Kasama]
“I think we just get scared of getting HIV and AIDS”[KII 3 participant, Mtendere Clinic, Lusaka]
“To avoid diseases and pregnancies”[FGD 2, participant 3, Namalundu Clinic, Kasama]
3.1.3. Child Spacing and Fear of Having More Children
“For me, I decided to get it [injectable contraceptive] so that I should not fall pregnant immediately because I have a child.”[FGD 2, participant 1, Chongwe Clinic, Chongwe]
“I looked at my child, she’s still young and so I’m scared to get pregnant again.”[KII 1, participant, Mtendere Clinic, Lusaka]
“Not wanting to have children without spacing is what influenced me.”[FGD 2, participant 5, Chongwe Clinic, Chongwe]
3.1.4. Prevent the Worsening of Poverty and Lack of Family Support
“If I am not ready to become a parent, I might make my child suffer for nothing. That is the main reason.”[FGD1, participant 1, Chongwe Clinic, Chongwe]
“Some [girls] it’s because of their social economic status at home. You will find that becoming pregnant is a cost they cannot afford.”[FGD 1, participant 4, Location Urban Clinic, Kasama]
“To reduce poverty, because you find that at home, they are not managing to feed everyone, so if I bring a baby, it would be worse.”[FGD 2, participant 2, Chongwe Clinic, Chongwe]
“People from home stop sponsoring [providing support] you once you fall pregnant.”[FGD 1, participant 9, Chongwe Clinic, Chongwe]
3.2. Motivations or Reasons for Non-Use of Contraceptives
3.2.1. Side Effects of Contraceptives
“When I was using Depo, I used to gain [weight] and my stomach would bulge up, so that was why I decided to stop.”[FGD 1, participant 2, Chongwe Clinic, Chongwe]
“The challenges I went through were unending periods, overweight too.”[FGD1, participant 2, Chongwe Clinic, Chongwe]
“Periods never end when I get the injection for 2 months. Sometimes the hand which receives the injection freezes.”[FGD 1, participant 7, Chongwe Clinic, Chongwe]
“When I first got the injection I had an unending flu, delayed with periods.”[FGD 1, participant 2, Chongwe Clinic, Chongwe]
3.2.2. Fear of Infertility
“The things people say about contraceptives. For example, people say when you take a pill, you will become barren, so that discourages us from getting them”[FGD 2 Participant 4 Chikoyi Clinic, Luwingu]
“People advise that getting contraceptives when you do not have a child means you will never conceive.”[FGD 1, Participant 9 Chongwe Clinic, Chongwe]
3.2.3. Mocking by Friends and Peers
“Some of the youths look down on their friends who get contraceptives, and they usually mock them, so this makes most of them shun away.”[FGD 1, Participant 9 Chongwe Clinic, Chongwe]
3.3. Influencers for Use and Non-Use
3.4. Intrapersonal Influencers
“For me, it was myself that initiated the idea of using contraceptives. I told myself that at my age I cannot afford to take care of a child. So, I decided to start using contraceptives.”[FGD 1, Participant 6 Location Urban Clinic, Kasama]
“For me, I fear labour as people die during labour. So, to avoid pregnancy I use a contraceptive.”[FGD 2, Participant 10 Chikoyi Clinic, Luwingu]
“It is the girl [who starts the decision] as we are the ones who fear to get pregnant.”[FGD 2, Participant 3 Chikoyi Clinic, Luwingu]
“It’s the lady. After the sex, you find the guy goes and it’s up to the lady to know how to protect herself from pregnancy.”[FGD 2, Participant 7 Namalundu Clinic, Kasama]
“We both discuss [contraceptive use] then come up with a decision [to use contraceptives].”[FGD 2, Participant 1 Chongwe Clinic, Chongwe]
“We exchange [initiating the discussion to use contraceptives], it can be me today and he will initiate it [the discussion] the next day. He used to remind me to go and get injections when I used to be on Depo.”[FGD 1, Participant 2 Chongwe Clinic, Chongwe]
3.5. Interpersonal Influencers
“I had a friend whose mom and my mom were friends. That friend of mine got pregnant and my mom was told. Immediately she came to me and said your friend is pregnant, should you also bring a pregnancy here, you will see what I will do to you. This motivated me to take a contraceptive.”[FGD 1, Participant 2 Location Urban Clinic, Kasama]
“For parents, they say if you get pregnant you will leave this place, so we take contraceptives in fear of our parents’ reactions.”[FGD 2, Participant 10 Chikoyi Clinic, Luwingu]
“Yes, because the way they talk that if you get pregnant, you will be killed or beaten and chased. So, this influenced me.”[FGD 1, Participant 2 Chongwe Clinic, Chongwe]
“The way my father talks that if I ever try to get pregnant, I will have a premature baby. When I hear this, I always get scared and end up getting contraceptives.”[FGD 1, participant 3 Chongwe Clinic, Chongwe]
“It was my friend. After I had sex with my boyfriend, I went to my friend, told her what happened. Then she told me about morning after pill.”[FGD 1, Participant 6 Location Urban Clinic, Kasama]
“We do influence each other by reminding each other to go and get the contraceptives.”[FGD 1, Participant 9 Chongwe Clinic, Chongwe]
“I heard from people that it [using contraceptives] is nice, and I decided to try.”[FGD 1, participant 2, Chongwe Clinic, Chongwe]
“For me, it was peer pressure. My friends influenced me to do it.”[FGD 2, participant 1, Chongwe Clinic, Chongwe]
“It’s not everyone that takes contraceptives because they know what they are doing. Sometimes it’s because of peer pressure or influence from friends. When they see their friends get Jadelle, they also feel they can insert Jadelle. They do it without knowledge of why they are doing it.”[FGD 1, participant 7, Location Urban Clinic, Kasama]
“There is fear of discrimination from friends. They may not want to be found with you if you get pregnant.”[FGD 2, Participant 8 Namalundu Clinic, Luwingu]
“Sometimes we also envy our friends who got married with weddings that is why we take contraceptives. We do not want to get pregnant as we fear we may not have weddings like our friends.”[FGD 1, Participant 7 Location Urban Clinic, Kasama]
“For me yes, because I share the same bed with her, so even if I get the condoms, she sees them and she uses them sometimes.”[FGD 1, Participant 3 Chongwe Clinic, Chongwe]
“For me, my aunt is my friend. So, we talk about these things.”[FGD 1, Participant 3 Chongwe Clinic, Chongwe]
“My sister…. She told me to go to the clinic and get family planning so that I do not fall pregnant again.”[KII 1, Participant Mtendere Clinic, Lusaka]
“For me, my boyfriend who told me that he wanted us to be having sex on a regular basis. I agreed and told him that I did not want to get pregnant especially if we will be having sex regularly which was maybe once after a day except the days I am on my menstrual cycle. So, he asked for time to find me a contraceptive. He searched and found one. He explained to me what it was, and he took me to the clinic where I got it. The contraceptive was Jadelle.”[FGD 1 Participant 2 Location Urban Clinic, Kasama]
“For me, my boyfriend told me he is not ready to get me pregnant, so he initiated the use of condoms.”[FGD 1 Participant 10 Location Urban Clinic, Kasama]
“We remind each other but most of the times it is me who always makes sure that there is a condom because sometimes men pretend not to have condoms. It is up to him if he thinks that I am a prostitute, but I know it is my life and I need to take caution. I do not see anything wrong with a woman carrying condoms because you are protecting yourself at the end of the day.”[FGD 1 Participant 3 Chongwe Clinic, Chongwe]
“It depends, if you plan to have sex with your boyfriend, he will be prepared with condoms. If it happens just at gunpoint, he will give you money to and buy a morning after pill. But if he does not, it’s up to you as a girl to think if you want to get pregnant or not. Then you will know what to do.”[FGD 1, Participant 7 Location Urban Clinic, Kasama]
“Sometimes the guy will after the sex give a lady money to go and buy a morning after pill.”[FGD 2, Participant 3 Namalundu Clinic, Kasama]
3.6. Organisational Influencers
“At my church, if you get pregnant, they make you stand in front of the church, and they ban you from going to church. So that makes us use contraceptives in fear of being banned from going to church.”[FGD 2, Participant 5 Chikoyi Clinic, Luwingu]
“These days in churches they disfellowship young ladies who fall pregnant. So, to avoid that, they end up using contraceptives.”[FGD 2, Participant 8 Namalundu Clinic, Luwingu]
“At our church, if you get pregnant, they stop you from going to church and taking part in church-related activities. So, we take contraceptives so that we do not get pregnant and be stopped from going to church.”[FGD 1, Participant 10 Chikoyi Clinic, Luwingu]
4. Discussion
4.1. Motivators for Contraceptive Use
4.2. Motivators for Non-Use of Contraceptives [1,27,36,37,38]
4.3. Influencers for Use/Non-Use [20,35,50]
4.4. Adolescent Girls’ Contraceptive Decision-Making Power
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CPR | Contraceptive Prevalence Rate | |
FGDs | Focus Group Discussions | |
KIIs | Key Informant Interviews | |
LICs | Low-Income Countries | |
NHRA | National Health Research Authority | |
SEM | Socio-Ecological Model | |
UKZNBREC | University of KwaZulu Natal Biomedical Research Ethics Committee | |
UNZABREC | University of Zambia Biomedical Research Ethics Committee | |
WHO | World Health Organization |
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Type of Interview | Facility Name | Total Number of Participants | Age Group | District | Geographical Location |
---|---|---|---|---|---|
FGD | Chikoyi Clinic 1 | 10 | 15–19 | Luwingu | Rural |
FGD | Chikoyi Clinic 2 | 10 | 15–19 | Luwingu | Rural |
FGD | Chongwe Clinic 1 | 9 | 15–19 | Chongwe | Rural |
FGD | Chongwe Clinic 2 | 6 | 15–19 | Chongwe | Rural |
FGD | Location Urban Clinic | 10 | 15–19 | Kasama | Urban |
FGD | Namalundu Clinic | 10 | 15–19 | Kasama | Urban |
FGD | Mtendere Clinic | 12 | 15–19 | Lusaka | Urban |
KII | Mtendere Clinic | 1 | 15–19 | Lusaka | Urban |
KII | Mtendere Clinic | 1 | 15–19 | Lusaka | Urban |
KII | Mtendere Clinic | 1 | 15–19 | Lusaka | Urban |
Total | 70 |
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Chola, M.; Hlongwana, K.W.; Ginindza, T.G. Motivators and Influencers of Adolescent Girls’ Decision Making Regarding Contraceptive Use in Four Districts of Zambia. Int. J. Environ. Res. Public Health 2023, 20, 3614. https://doi.org/10.3390/ijerph20043614
Chola M, Hlongwana KW, Ginindza TG. Motivators and Influencers of Adolescent Girls’ Decision Making Regarding Contraceptive Use in Four Districts of Zambia. International Journal of Environmental Research and Public Health. 2023; 20(4):3614. https://doi.org/10.3390/ijerph20043614
Chicago/Turabian StyleChola, Mumbi, Khumbulani W. Hlongwana, and Themba G. Ginindza. 2023. "Motivators and Influencers of Adolescent Girls’ Decision Making Regarding Contraceptive Use in Four Districts of Zambia" International Journal of Environmental Research and Public Health 20, no. 4: 3614. https://doi.org/10.3390/ijerph20043614